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What are the Islamic rulings regarding a person who has had a stoma bag fitted

QUESTION

What are the Islamic rulings regarding a person who has had a stoma bag fitted, for example can he wear it to the mosque, when does wudhu break etc.?

ANSWER

[FULL QUESTION]

A stoma is an artificial opening from a part of the bowel onto the
surface of the skin allowing a patient to excrete their waste products into a
bag. This type of surgerybecomes necessary because of diseases causing inflammation of the bowel
or because of a blockage often from a cancer.

When we make these stomas it is usually permanent but can be a temporary
measure. My questions are geared to those people in which this becomes a
permanent feature. There are two types of stoma.

An ileostomy- which comes from the small intestine making the contents
like a smelly liquid...when patients have this they continuously and
unpredictably pour this water into their stoma bag. The water is also very
corrosive to the skin so if they wash it too many times it causes irritation.
Also if they pour too much out, which is common, they can lose vital
electrolytes and minerals making them prone to dehydration.

A colostomy is from the large bowel, so the contents are like faeces. It
empties out 1-2 a day and people who have this can often 'predict' when this
will happen. No electrolyte problems occur but if they don't eat well or fast
they can become constipated blocking the stoma and making them come into
hospital for treatment. Please see pictures attached for further clarification.
Questions for the sheikh are;

1) For patients with a stoma (any kind)- what special conditions can they adopt
in terms or prayer. Can they combine/ shorten- making them less prone to handling
a stoma avoiding the problems above

2) Are these people classed as 'ill' so is fasting not compulsory for them
given the risks of dehydration and/or constipation?

3) What washing conditions apply for them- for example in a stoma some patients
cannot control passing wind- does that mean they have to do wudhu every time
this happens?

4) What if they have an odour (of faeces) because some bags are made that way-
are they allowed to pray in jamaat?

5) What precautions do they have to do when performing haj?

6) Where should we place this stoma as surgeons- choice between left side of
body and right- is there any religious ruling with regards to this?

7) What do we say to those Muslims who refuse this surgery because of the
taboos to this type of surgery- are they committing a sin- because in some
cases they are almost certainly going to die without it?

8) Similar to the problem above- what if during salaat an ileostomy pours out
liquid into the bag- this is almost always unavoidable- do they continue
praying?

9) Changing and washing a bag and stoma can be very arduous and
it is recommended that there is limited handling of the stoma, can Muslims
combine their prayer because of this reason?

10) I would also be interested to know whether the Sheikh has
ever encountered being approached by a Muslim to discuss matters prior to
surgery. Are these issues ever discussed during Kutbahs or is there an advice
service with regards to health issue at the mosque they are based in?

And what general advice would he give with regards to this issue?

الجواب حامداً و مصلياً

Answer

Before answering each of your questions
individually, it seems pertinent to make some introductory points related to
the questions asked.

It is important to note
that the person who is required to wear the stoma bagandwho has impurities which constantly exit from the body
such as stool, urine, wind etc.is regarded in Shariah
as being in the ruling of someone wearing a Jabirah or Isabah (cast, bandage
or dressing for an injury).

Thus, Wudhu (ablution)
will remain intact and valid for these stoma patients as long as the said
impurities do not exit the stoma bag, just as Wudhu remains valid for a
person wearing a bandage, even if the bandage contains blood from a wound. However,
in the case the impurities do exit the bag, for example there is a leakage, Wudhu
would be invalidated.

On the other hand, if as
in some cases the type of stoma bag utilised allows wind to exit the stoma bag
via perforations, then a different ruling to the above is applicable. Here, the
Wudhu would be invalidated, as the wind in this situation would constantly
exit both the body and the bag via the perforations. In this scenario the
person will be regarded in the Shariah as Ma’zur (excused).

The ruling of the Ma’zur
person is that they will only need to make aWudhu at the
start time of the Salah (prayer) and it will suffice for the entire Salah
time, subject to the fact that the Wudhu is not invalidated by any other
factor which nullifies Wudhu, such as bleeding from another part of the
body etc.

After performing Wudhu,
a Ma’zur person may pray and perform other forms of worship which
require Wudhu, such as reading Qur’an etc.

Similarly, it is not
prohibited for a person with a stoma bag to enter a mosque or to perform Tawaf
(circumambulation of the Kaba), on the condition that they are sure that they
will not soil the masjid area and there is no unpleasant odour which could
inconvenience other worshippers.

It should be clear that,
the stoma bag which is attached to the bodyof the stoma patient is
permitted to be worn during Salah and can be taken into the mosque, as
it is a medical necessity.

However, a used bag containing
impurity which is not being used by the patient cannot be taken into the mosque,
as doing so contravenes the sanctity of the masjid. Indeed nor is it permitted that such used
bags be carried on one’s person for example in a ruck sack etc. whilst praying
outside the mosque, as carrying such impurities during prayer would contravene
the prerequisite of one’s cleanliness for the Salah.

It should be noted
that, in the abovementioned situation if the person’s clothing becomes frequently
and repeatedly soiled by the said impurities in such a way that washing the
clothing is of no benefit. For example if the clothing keeps on getting soiled as
soon as it has been washed, in this situation the patient will also be
considered excused from having to wash or change the soiled clothing for Salah.

If however the clothing
is soiled infrequently in such a manner that one could offer the prayer without
the clothing getting soiled, the normal ruling is applicable, i.e. the area to
the extent of an average sized coin of impurity is excused. In the case that
the impurity covers a greater area than that, then the effected article of
clothing must be washed or changed.

After these
introductory remarks, we will now answer each question below in light of the
above detail:

1...In the above
mentioned scenario, prayers may be prayed together to reduce hardship, for
example the end time of one prayer and the beginning time of the next prayer
are utilised. However prayers cannot be shortened (Qasr) as that
dispensation is specific to travellers.

2...With regards to
fasting in the holy month of Ramadhan, stoma patients may fast on the
condition that there is no medical reason preventing them from doing so. If
they cannot fast due to medical advice, which also indicates that they are unlikely
to be able to fast in the future, then they can pay Fidya (a charitable
donation given to the poor) as for the missed fasts.

However, if according
to medical advice the patients’ health is likely to improve in the future
enabling them to fast, then in this situation the missed fasts are to be made
up (Qadha) as and when it becomes possible for them to do so.

To assess if one is
able to fast or not, one should initially make an attempt to fast, however, at
the first instance of finding any difficulty due to the medical condition, one
should end the fast immediately and follow the abovementioned rulings regarding
missed fasts.

3/4...Please refer to the
above introduction

5...The Haj (the
pilgrimage to Makka) may be performed by a person with a stoma subject to
medical advice. If one is medically advised to avoid the journey, then such a
person will be excused from performing Haj. However, if Haj had
already become obligatory on the person prior to having had the stoma, then in
this situation, the obligation of Haj remains after the stoma surgery.

Although in this
situation it is permissible, to have someone else perform Haj on the
behalf of the patient, if one cannot perform it due to the hardship arising
from the medical condition.

6...In principle the
positioning of the stoma should be decided according to the best position
available from a medical perspective. However, in the situation where there is
a choice, then it is preferable that the stoma be positioned in such a way that
it facilitates the using of the left hand to empty the stoma bag and enables sleeping
on the right hand side.

It should be clear that
these two points are not a requirement; rather they are a part of Islamic
etiquette for personal hygiene which encourages one to use the left hand for
cleaning and relieving oneself (and the right hand for eating). Similarly
sleeping on the right-side is considered an Islamic etiquette for adopting a
restful sleep posture.

However, these
etiquettes are to be avoided, if they compromise in any way, the health and
wellbeing of the stoma patient.

7...With regards to the
ruling of whether one must undergo surgery and other forms of medical treatment
or whether it is optional, the Shariah instructs Muslims that they should accept
medical treatment if according to medical opinion, it is on the balance of
probabilities likely to be successful. However, if they do not wish to undergo
medical treatment then it is not regarded as sinful.

On the other hand, if
the type of surgery was on the balance of probabilities merely speculative in
nature in terms of a successful outcome, in this situation it is conversely not
recommended to undergo such surgery, however, if one still chose to do so, it
is not held as impermissible.

8... Please refer to
the introduction.

9... Please refer to
answer number 1.

10...Our general advice
regarding these type of contemporary issues is that, it is important to
appreciate that these are essentially new issues which have recently arisen, as
these new forms of modern surgery and medical treatment were not historically
available in the past, thus they require new research from a Shariah
perspective, to clarify the appropriate rulings regarding them.

It is also worth noting
that due to the very nature of these often complex and detailed issues, they
are often best dealt with in an appropriate and suitable forum, ideally where
both Shariah experts and medical practioners contribute to the discussion.

As for why stoma
related issues are not usually discussed in mosques etc. it may well be that the
technical nature of the subject area generally precludes it from being
addressed in Friday sermons and similar religious gatherings. Also another
contributory factor for a lack of discussion in the mosques regarding stomas is
perhaps due to the fact that it is often difficult to find suitably qualified
scholars to explain such matters. As a scholar would not only need to have the
appropriate expertise regarding the applicable Shariah rulings, but importantly
he must also have the requisite understanding of the relevant medical back
ground related to the issues under discussion.

Finally, it is
commendable that you have sought to find answers from a faith perspective with
regards to these important questions to help meet the needs of your Muslim patients.
Hopefully, the above answers are of some help and go towards fulfilling that
need.